Housing First in Europe The Solution to Homelessness? Nicholas Pleace Centre for Housing Policy

Europe European Union (28 member states) Norway, Switzerland, Balkans Germany, UK and France are economies 4,5,6 The EU is, collectively, the World’s 2nd largest economy But a lot of Europe is less prosperous Stark inequalities Around 508 million people in EU (soon to be minus 66 million when UK leaves)

Homelessness No single European definition Most countries agree that people living rough and in emergency accommodation are ‘homeless’ ETHOS from FEANTSA physical domain (exclusive space), social domain (private space) and legal domain (some security of tenure) Similar to Australian Bureau of Statistics (ABS) definition adequate dwelling, have reasonable security of tenure and space for social relations.

Homelessness policies in Europe Do not have the same target Denmark, Finland and the UK target hidden homelessness Other countries are targeting street homelessness/rough sleeping and people in shelters

Different policies Off the streets (Warehouse) Treat, accommodate and rehouse Integrated Housing-led approaches, provide independent homes and support

Different policies Not just at the level of individual countries There are often elements of warehousing, treatment-led and housing-led policies in the same country Coherent, integrated national strategies do exist Denmark, Finland But there is also inconsistency and variation Germany, Sweden, UK

The case for Housing First Work of Dennis Culhane and others in the USA Showed the presence of a small, high cost, high risk population around 15% of total Growing evidence that linear residential treatment/ ‘staircase’ services were not effective with that specific group And were expensive Housing First offered a solution that was more cost effective

The case for Housing First Evidence of the same sort of patterns in North Western Europe Less economic homelessness than in the USA But still a small high cost, high risk group not being reached Denmark, Ireland, UK, Finland, France

The case for Housing First Long-term/recurrent rough sleepers High and complex needs Not engaging with existing services Frequent flyers Somewhat more numerous Long-term and recurrent homeless Stuck in homelessness services And heavy contact with hospitals, mental health, Police…

The case for Housing First Money is being spent But the highest need people are not being helped The drivers behind the Finnish national strategy exist elsewhere And Housing First appears to offer the answer

European Successes Every time Housing First is deployed in Europe it appears to work Tiny pilot projects held together with string in the UK, Sweden, Italy Full-fat government programmes, Denmark, Finland and the French RCT trial, Un Chez-Soi d’abord (2011-2016) and subsequent national programme 7-9 people out of 10 housed @ 1 year

But Not quite so simple Ambiguity Limits Risks

Ambiguities

Will the real Housing First please stand up? Sam Tsemberis and others argued strongly for fidelity, for near- replication of the original New York model Because of what happened in the US Federal funding for loosely defined Housing First Spartacus/Brian response Sometimes little more than changing the sign

Differences Adaptation to Europe Existing practice e.g. Germany/Finland/UK Welfare state in miniature model does not make a lot of sense in North Western European countries Universal welfare systems Universal health systems Extensive social housing So intensive case management (ICM) only models used

A bit more difference Full tenancies in social rented housing Not sub letting/a lease No financial controls No service making sure bills are paid first Deemphasising behavioural modification Harm reduction Greater emphasis on choice and control Not just consumer choice, but co-production Congregate models Not scattered but clustered Targeting All long term/repeat homelessness, no chaos indices, no mental health diagnosis

Never mind the fidelity… Very high “fidelity” in France Quite high in Denmark But different elsewhere Crucially though, all these services are reported as successful

Consistency Choice and control Harm reduction Separation of housing and support Own, settled home with mobile support Housing plus user-led support services But not on the operational details And not on the behavioural modification

Limits

Evidence base Is still largely North American Housing First is often being compared with treatment as usual that is not the same as European homelessness services Harsher, abstinence based Operating in a different context and culture

Evidence base Top at rehousing But, while you have to allow time, less certain on Mental and physical health Drugs and alcohol Social integration Including the long-term study (5 years) Padgett et al in USA And European evidence base Guy Johnson; Sharon Parkinson; Cameron Parsell (2012) Policy shift or program drift? Implementing Housing First in Australia

Key criticisms Is it just dispersed warehousing (Americans) Not really sustainable if you look at qualitative evidence Its not doing anything beyond housing (Americans) Some truth in this, but can you expect a miracle cure from one intervention (Volker Busch Geertsema) or expect it to work very quickly, bearing in mind who it is meant for? It is still behavioural modification using flawed North American constructs of homelessness as deviant individual pathology (European sociologists) True coproduction can be achieved, some truth in relation to original model Misses some people

Limits Housing First is for people with high and complex needs France, Ireland, UK, most homelessness is not like that Economic causation Domestic violence and family homelessness Crucial US evidence showing that support/treatment needs can develop after homelessness, it is better to prevent (and probably cheaper)

Different environments In Denmark and Finland, Housing First is being used to reduce a residual social problem Homelessness is a hugely damaging thing to happen But the extensive social protection in these countries makes it unusual Danish and Finnish homeless people have higher and more complex needs and have fallen through extensive, universal safety nets Not so elsewhere, less protection from homelessness being triggered by poverty

Cost effectiveness Best American evidence tends towards concluding that Housing First costs about the same But achieves better rates of rehousing Making it more cost effective More limited UK and European evidence suggests a similar pattern Cost offsets for other services may sometimes be large But Housing First will sometimes cause a spike in other spending And someone has to be costing a lot before the financial advantages are really clear

Risks

Housing First solves homelessness? It can get people with high and complex needs off the street and stop frequent flying But it only solves homelessness if you define homelessness in those terms And it cannot be 100%, in who it helps or meeting every need That is what it was designed to do in the first place and its creator would not claim more than that for it If homelessness is families, children and poor people with low or no support needs then no, Housing First doe not solve homelessness And it is reactive, not preventative in design

Think carefully about the evidence North American Basis for comparison is not the same Many UK services, for example, are harm-reduction, user-led and housing-led In UK, services being criticised as ‘obsolete’ and ‘ineffective’ compared to Housing First, based on comparisons made with very different services in North America Using one indicator of ‘success’, which is ending physical homelessness among people with high and complex needs It is a misrepresentation to simply portray all pre-Housing First models as inherently ineffective

Using Housing First effectively There are long-term and repeatedly homeless people it can reach Frequent flyers and those who avoid all but basic services But that is not all homelessness Need to look beyond individual services or programmes and think about how Housing First is used

The Finnish example Housing First is part of an integrated homelessness strategy Prevention Building of new social housing A mix of lower and higher intensity services, just one of which is Housing First Housing First is targeted, it does a specific job Finnish Housing First is also an ethos, a philosophy

Structures There has to be an adequate, affordable housing supply with reasonable security of tenure Without that Housing First will not work You need housing if you are serious about homelessness prevention and about rapid rehousing

The best solution Broadly speaking the more extensive the welfare and social policy spending that a society has, the more safety nets there are… The less homelessness there will be A key lesson from Europe is that If a society does nothing much about affordable housing supply, allows extremes of poverty to occur, does not look after citizen’s health there will be more homelessness

The best solution Housing First can help when people with complex needs fall through existing safety nets and avoid the risk of ‘frequent flyers’ getting stuck in lower intensity services There is a strong case, but look at what the Finns do You also need prevention, rapid rehousing, lower intensity services, Housing First, high intensity supported housing And sufficient homes

Thanks for listening Nicholas Pleace Centre for Housing Policy University of York European Observatory on Homelessness Women’s Homelessness in Europe Network